MRI检测预测经皮椎体成形术后再骨折及相关因素

MRI detection predicts refracture and related factors after percutaneous vertebroplasty

摘要:

[目的] 探讨MRI 及其弥散加权成像（diffusion weighted imaging, DWI） 对经皮椎体成形术（percutaneous vertebro-plasty, PVP） 术后同椎体再发骨折的预测价值。[方法] 2020 年1 月—2022 年6 月在盘锦辽油宝石花医院接受PVP 治疗的80例患者纳入研究，依据术后同椎体有无再发骨折分为再骨折组与未骨折组。单因素及多因素逻辑回归分析再发骨折的危险因素，ROC 曲线分析表观扩散系数（apparent diffusion coefficient, ADC） 对再发骨折的预测效能，相关性行Pearson 分析。[结果] 术后随访时间平均（18.0±4.0） 个月，同椎体再骨折发生24 例（30.0%）。单因素比较：再骨折组骨密度T 值[(-3.6±0.8) vs(-3.2±0.6), P=0.016] 显著低于未骨折组，术前IVC 占比[是/否, (9/15) vs (2/54), P＜0.001]、骨折线累及终板占比[是/否, (13/11) vs(16/40), P=0.029]、术后骨水泥周围积液占比[是/否, (9/15) vs (4/52), P=0.002]、椎体高度恢复率[(10.5±2.5)% vs (6.5±2.2)%, P＜0.001] 及ADC 值[(1.8±0.5)×10^-3mm²/s vs (1.0±0.3)×10^-3mm²/s, P＜0.001] 均显著大于未骨折组。多因素逻辑分析显示：术前IVC（OR=8.864, P=0.005）、ADC 值（OR=3.241, P=0.024）、椎体高度恢复率（OR=2.746, P=0.012）、术后骨水泥周围积液（OR=2.261, P=0.029） 是术后同椎体再发骨折的独立危险因素。ADC 值预测再发骨折的曲线下面积为0.953。ADC 值与骨密度T 值呈显著负相关（r=-0.335, P＜0.001），与椎体高度恢复率呈显著正相关（r=0.250, P＜0.001）。[结论] MRI-DWI 对PVP 术后同椎体再发骨折有一定的预测价值，通过对MRI 对DWI-ADC 值、IVC 等危险因素评估，可能有利于预防术后骨折再发。

Abstract:

[Objective] To investigate the predictive value of diffusion weighted imaging (DWI) of MRI in recurrent fractures of thesame vertebra after percutaneous vertebroplasty (PVP). [Methods] From January 2020 to June 2022, 80 patients who received PVP treat-ment in Liaoyou Baoshihua Hospital of Panjin were included in the study, and were divided into the refracture group (the RF group) and thenon-fracture group (the NF group) according to whether there was a refracture of the same vertebra after surgery. The risk factors of recur-rent fracture were analyzed by univariate comparison and multivariate logistic regression, the predictive efficacy of apparent diffusion coeffi-cient (ADC) in recurrent fracture was analyzed by ROC curve, and Pearson analysis was performed for the correlation. [Results] As followupperiod lasted for (18.0±4.0) months in a mean, 24 cases (30.0%) proved refracture at the same vertebral body. As results of univariatecomparison, the RF group had was significantly greater than the NF group in terms of bone mineral density T value [(-3.6±0.8) vs (-3.2±0.6), P=0.016], preoperative IVC ratio [yes/no, (9/15) vs (2/54), P＜0.001], fracture line involved end-plate ratio [yes/no, (13/11) vs (16/40),P=0.029], postoperative fluid accumulation around bone cement ratio [yes/no, (9/15) vs (4/52), P=0.002], vertebral height restoration rate[(10.5±2.5)% vs (6.5±2.2)%, P＜0.001] and ADC values [(1.8±0.5) 10^-3mm²/s vs (1.0±0.3) 10^-3mm²/s, P＜0.001]. As for multivariate logisticanalysis, the preoperative IVC (OR=8.864, P=0.005), ADC value (OR=3.241, P=0.024), vertebral height recovery rate (OR=2.746, P=0.012), postoperative fluid accumulation around bone cement (OR=2.261, P=0.029) were the independent risk factor for recurrent fractureof the same vertebra after surgery. The area under the curve (AUC) predicted by ADC values for recurrent fractures was 0.953. In addition,the ADC values were negatively correlated with bone mineral density (r=-0.335, P＜0.001), whereas positively correlated with vertebralheight recovery (r=0.250, P＜0.001). [Conclusion] MRI-DWI has a certain predictive value for the recurrence of the same vertebral bodyfracture after PVP. By evaluating the risk factors such as DWI-ADC value and IVC value of MRI, it may be beneficial to prevent the recur-rence of fracture after PVP.